Thromboendarterectomy dissector and suction instrument

ABSTRACT

A suction dissector for performing coronary, systemic or pulmonary thromboendarterectomy includes a unitary elongated instrument having an elongated tubular handle section and an elongated tubular probe section having a bore. The handle section has a connector at an outer end thereof for attachment to a source of vacuum. The probe section has a rounded tip and a plurality of ports in the tip for communicating with the bore. The probe section may angled relative to the handle.

REFERENCE TO RELATED APPLICATION

This application is a continuation of application No. 07/990,908, filedDec. 15, 1992 (now U.S. Pat. No. 5,358,507 granted Oct. 25, 1994, whichis a Continuation-In-Part of Application Ser. No. 07/736,404, filed Jul.26, 1991, now abandoned, and entitled "Cardiac ThromboendarterectomySuction Dissector".

BACKGROUND OF THE INVENTION

The present invention relates to surgical instruments and procedures andpertains particularly to improved thromboendarterectomy instruments andmethod of use.

Many cardiovascular diseases involve arteriosclerosis or cloggedsystemic and pulmonary arteries. Many heart and circulatory problems aredue to clogged or restricted arteries. Arteries become clogged due toplaque buildup on the walls of the arteries as well as clot formationand/or embolization. Surgical techniques have been developed in the pastfor cleaning out or unplugging many of these arteries.

These techniques involve the use of special surgical instruments in theform of various shaped scrapers that are inserted in the artery toseparate and dislodge the plaque material from the arterial walls.Various implements have been proposed and utilized for this procedure inthe past. Most of these instruments are referred to as dissectors andresemble tiny spoons or spatulas on the end of a long slim rod.

Pulmonary thromboendaractomary also normally involves frequent periodsof circulatory arrest. Even during circulatory arrest, continued backbleeding obscures the operative field. This requires frequentinterruption of the procedure to allow aspiration of the operative fieldwith a second instrument. These interruptions obviously extend theperiods of circulatory arrest, sometimes to the detriment of thepatient.

It is, therefore, desirable that improved implements and procedures beavailable which effectively remove plaque and the like from arteries andprovide aspiration to remove blood at the same time.

SUMMARY AND OBJECTS OF THE INVENTION

It is the primary object of the present invention to provide an improvedinstrument for the removal or separation of plaque, clot and the likefrom artery walls.

It is another object of the present invention to provide an improvedmethod for the removal or separation of plaque and the like from arterywalls.

In accordance with a primary aspect of the present invention, animproved endarterectomy instrument includes an elongated tubularinstrument having means for connection to a suction source and having aspherical tip for insertion into an artery for dissection and removal ofplaque and the like.

Another aspect of the invention includes an improved endarterectomyinstrument set having a plurality of elongated tubular instrumentshaving means for connection to a suction source, and each having anelongated probe extending at a different angle to the handle, with aspherical tip for insertion into an artery for removal of plaque and thelike.

A further aspect of the invention comprises an improved endarterectomyprocedure using an instrument set having a plurality of elongatedtubular instruments having means for connection to a suction source, andeach having an elongated probe extending at a different angle to thehandle with a spherical tip for insertion into an artery for thesimultaneous aspiration of fluids and removal of plaque and the like.

BRIEF DESCRIPTION OF THE DRAWING

The above and other objects and advantages of the present invention willbecome apparent from the following description when read in conjunctionwith the accompanying drawings wherein:

FIG. 1 is a top plan view illustrating a set of instruments inaccordance with the preferred embodiment of the present invention;

FIG. 2 is an enlarged detailed section view showing details ofconstruction of a tip of an instrument in accordance with the invention;

FIG. 3 is a side elevation view in section showing an instrument inaccordance with the invention in use; and

FIG. 4 is a schematic illustration of a system incorporating aninstrument of the invention.

DETAILED DESCRIPTION OF A PREFERRED EMBODIMENT

Referring to FIG. 1 of the drawings, a set of instruments in accordancewith the invention is illustrated and designated generally by thenumeral 10. The instruments, as will be appreciated, are similar inconstruction, with each having an elongated probe tip that extends at adifferent angle to the handle. These instruments are referred to asendarterectomy dissectors.

Referring to FIG. 1, there is illustrated a kit comprising a pluralityof instruments comprising a first dissector 12 of a hollow or tubularconfiguration having a handle section 14 for grasping, with an elongatedconverging section 16 extending downward to an elongated probe section18 having a small diameter and a larger rounded or spherical tip 20. Thetip may have substantially any configuration, but the enlarged sphericalconfiguration is preferred. The handle 14 has a port at an end 22 forattachment to a vacuum source and cell saving device. The probe sectionof the instrument 12 is aligned with and coaxial of the handle 14. Theprobe section has a diameter preferably on the order of about 1.5millimeters, and a tip 20 which is preferably generally spherical inconfiguration and having a diameter of on the order of about two (2)millimeters. This tip is designed to act as a blunt dissector byengaging and forcing plaque and the like away from artery walls.

Referring to FIG. 2, the tip 18 is provided with a pair of cross boresextending at ninety degree angles therethrough defining a plurality ofsuction ports 24, 26 disposed around the periphery of the tip or head 20and communicating by way of the internal bores, with an internal passage28 of the probe. This instrument has been found to be effective whenconnected to a vacuum source and inserted into an artery to strip awayplaque or clot therein, while at the same time removing blood and otherfluids. These dissectors perform the combined function of bluntdissection and aspiration. They continually remove blood and otherfluids as well as plaque and/or clot particles from the artery as theyare being manipulated therein. This eliminates the need for stopping thedissection repeatedly and to aspirate blood from the operative fieldwith a second instrument.

The instrument set or system comprises a plurality of the instruments12, 30, 32, 34, 36 and 38. The main difference between the instrumentsis in the length and angle of the probe tip section with respect to thehandle. The probe lengths vary from about three to about sevencentimeters (cm). The angle varies from zero up to just short of ninetydegrees. The angle and tip lengths of the dissector tips facilitatedissection of all of the bronchopulmonary segmental arteries of thelungs as well as those of the heart and rest of the body.

The instrument 30 is shown with a tip 40 having an angle of on the orderof about fifteen degrees to the axis of the handle. This angle may varysome from this, but on the order of about this angle is desired forcertain operations. The distance from the angle to the tip is about five(5) centimeters.

The instrument 32 is illustrated as having a probe tip 42 that is on theorder of about thirty degrees from the angle of the axis of the handle.This angle may vary slightly as desired. The length from the angle tothe tip is about five (5) centimeters.

The instrument 34 is illustrated having a tip 44 on the order of aboutforty-five degrees to the axis of the handle. Again, this angle may varyslightly, depending on various factors. The length of the probe from theangle to the tip is about five (5) centimeters.

The instrument 36 is illustrated having a probe tip 46 of on the orderof about sixty degrees from the axis of the handle. The length of theprobe from the angle or bend to the tip is about five (5) centimeters.These dissectors, as will be appreciated, enable the surgeon to selectthe instrument having the tip at the proper or desired angle for theparticular situation encountered.

The instrument 38 is shown to have a probe tip 48 on an angle just shortof ninety degrees or on the order of about eighty to eighty-five degreesto the axis of the handle. This, of course, may extend up to ninetydegrees, if desired. The length of the probe from the angle to the tipis on the order of about three (3) centimeters.

It will also be appreciated from viewing the instruments in FIG. 1 thatthe straight section of the probe tip may vary in length from its fulllength at the juncture of the transition section down to shortersection, as will be appreciated. The instrument 12, for example,preferably has a section that is on the order of approximately sevencentimeters in length, with others having an angled straight portionbeing on the order of about five centimeters in length, with instruments38 being on the order of about three centimeters in length. The tip ispreferably on the order of about two millimeters in diameter, with theports 24, 26 being on the order of about 0.5 millimeters in diameter.

Referring to FIG. 3, there is illustrated an example with instrument 12in use, with the probe section 18 extending into the bore of an artery50 and stripping plaque 52 away from the wall of the artery. The probe18 with its tip 20 is shown to have forced a portion of the plaque awayfrom surface of the wall. The instrument draws blood and other fluidsinto the ports from all directions around it while plaque or likematerial is being removed.

Referring to FIG. 4, a dissector 12 is shown connected by means of astandard suction tubing 54 to a suction unit or vacuum source 56. It maybe connected to any suitable vacuum source, such as a wall suction, aCell Saver device, or cardiotomy suction to conserve blood. Blood,plaque and other debris drawn in via the dissector may be collected in ascreen or the like for disposal. The instruments are preferablyconstructed of stainless steel and fitted in a stainless steelsterilizing case. However, the instruments may be constructed of asuitable plastic material and be disposable.

In operation, an instrument having the appropriate angle probe tip isselected, the instrument is connected by a flexible tubing to a sourceof vacuum, such as a vacuum pump. Access to an artery is obtained andthe instrument is inserted in the correct plane along the artery,probing therein simultaneously aspirating blood and other debris fromthe interior of the artery while separating plaque, clot and the likefrom the wall of the artery. The tip of the instrument is probed alongthe wall and through an occluded area of the artery forcing all plaqueaway from the wall. The plaque may be grasped by tweezers or a likeinstrument and pulled from the artery as it is stripped from the wallsthereof.

While I have illustrated and described my invention by means of specificembodiments, it should be understood that numerous changes andmodifications may be made therein without departing from the spirit andscope of the invention as defined in the appended claims. I furtherassert and sincerely believe that the above specification together withthe accompanying drawings contains a written description of theinvention and the manner and process of making and using it, in suchfull, clear, concise, and exact terms as to enable any person skilled inthe art to which it pertains, or with which it is most nearly concerned,to make and use the same, and further that it sets forth the best modecontemplated by me for carrying out the invention.

I claim:
 1. A combination dissector and suction instrument forperforming pulmonary thromboendarterectomy, said instrument comprising:aunitary elongated tubular member, said member having a handle section onone end thereof and having means for connection to a source of vacuum,an elongated substantially rigid probe section adapted for insertion inand extension along an artery, said probe section having an unobstructeduniform cylindrical outer surface of from three to seven cm in lengthand 1.5 mm in diameter with a rounded tip of about 2 mm in diameterhaving a plurality of suction inlet ports and, said probe sectionextending at an angle to said handle section of between from about zeroto about eighty degrees.
 2. An instrument according to claim 1 whereinsaid ports are circular and about 0.5 mm in diameter and disposed atabout ninety degree intervals about said tip.
 3. An instrument accordingto claim 1 wherein said probe section is about 3 cm in length and atabout an eighty degree angle to said handle.
 4. A combination dissectorand suction instrument instrument for performing thromboend-arterectomy,comprising:a unitary elongated tubular member, said member having ahandle section on one end thereof and having means for connection to asource of vacuum, an elongated substantially straight rigid probesection adapted for insertion in and extension along an artery, saidprobe section having an unobstructed uniform cylindrical outer surfaceof at least three cm in length with a rounded tip having a plurality ofsuction inlet ports and, said member having said probe section extendingrelative to said handle section, a selected one of fifteen degrees,thirty degrees, forty-five degrees, sixty degrees and eighty degrees tosaid handle section, respectively, wherein said rounded tip is sphericaland two mm in diameter and has four circular suction inlet ports of 0.5mm in diameter.
 5. An instrument according to claim 4 wherein the probesection is from about 3 cm to about 7 cm in length.
 6. An instrumentaccording to claim 5 wherein said probe section has an unobstructeduniform cylindrical outer surface.
 7. An instrument according to claim 6wherein said probe section is about 3 cm in length and at about aneighty degree angle to said handle.
 8. An instrument according to claim4 wherein said probe section has an unobstructed uniform cylindricalouter surface from about 3 cm to about 7 cm in length.
 9. An instrumentaccording to claim 8 wherein said ports are disposed at about ninetydegree intervals about said tip.
 10. An instrument according to claim 9wherein said probe section is about 3 cm in length and at about aneighty degree angle to said handle.
 11. An instrument according to claim4 wherein said probe section is about 3 cm in length and at about aneighty degree angle to said handle.
 12. A method of performingthromboendarterectomy, said method comprising the steps of:selecting acombination dissector and suction instrument of unitary elongatedsubstantially rigid structure having an elongated tubular handle sectionand an elongated tubular probe section having a through bore, saidelongated tubular handle section having means at an outer end thereoffor attachment to a source of vacuum, said elongated tubular probesection having a rounded tip and a plurality of ports in said roundedtip communicating with said bore, said combination dissector and suctioninstrument having said elongated tubular probe section extending aselected one of, coaxially with said elongated tubular handle section,and at an angle to said elongated tubular handle section of betweenabout fifteen degrees and about eighty degrees, relative to said handlesection; connecting said outer end of said combination dissector andsuction instrument to a vacuum source; and inserting said elongatedtubular probe section of said combination dissector and suctioninstrument into and moving it along an artery forcing plaque from wallsthereof while simultaneously therewith operating said source of suctionto maintain an area around said rounded tip substantially free offluids.
 13. A method according to claim 12 wherein said angle to saidelongated tubular handle section of between about fifteen degrees andabout eighty degrees, comprises a selected one of fifteen degrees,thirty degrees, forty-five degrees, sixty degrees and eighty degrees,respectively.
 14. A method according to claim 12 wherein said roundedtip is two mm in diameter and said plurality of ports includes fourcircular vacuum ports of 0.5 mm in diameter.